My father has always been a fitful sleeper -- rolling from side to side in a tangle of blankets, waking up with his smoker’s hack and reaching for a cigarette, getting up to relieve his beer-swollen bladder. When he found sleep, his loud snores roared through the house.

I entered his room at Detroit’s St. John’s Hospital. He lay on his back in the narrow bed, eyes closed. His ashen skin, withered and dry, pulled tight around his cheekbones. Someone had combed his sandy hair, probably my mother, I thought, because the part and wave were just right. The white sheets, folded over a pale-yellow blanket, lay straight across his shoulders. His head barely indented the pillow.

My father slept soundly that night while we talked about his condition. My sister, Dianne, a nurse, reached over, lifted the blanket, and showed my mother and me the black spots covering the sole of his right foot. Gangrene, she explained. The artery in Dad’s groin, punctured for a heart catheterization, had become infected, and subsequent surgery failed to increase the blood flow to his lower leg. The next surgery would be a complicated procedure that involved taking a vein from Dad’s good leg and using it to bypass the infected area in the groin. About a 20% chance of success for an 80-year-old. Otherwise, amputation.

***

My mother decided to leave rather than wait for the 3:00 a.m. surgery. Dianne would stay with Dad. In the car on the way to my parents’ house, I asked my mother about Dad’s health. In the weeks before the first surgery, she said, he had been complaining of chest pain, but she didn’t take him seriously. His daily regimen of two packs of Camels, a six-pack or more of beer, and a diet that led to a cholesterol count in the three hundreds made sympathy difficult. They finally made an appointment with his heart doctor, who examined him in the morning and scheduled an emergency heart catheterization for that afternoon. After the outpatient surgery, Dad sat in the passenger seat on the 20-mile drive home to Lexington. He stared out the window at the moon reflecting on Lake Huron, took a long drag on his cigarette, and said, “You know, Mom, the worst thing about surgery was going so long without a smoke.”

After breakfast the next day, Dad weeded one of their flower beds. That evening, he felt pain in his groin. At first, he thought he had pulled a muscle while gardening. Over the next two weeks, his doctors told him that he had a bruise, a bladder infection, and then a hernia. Each day, the pain grew worse. He took Tylenol. Then a doctor prescribed Tylenol 3. He cut his drinking to three or four bottles of beer a day, but continued to smoke, and this, we later found out, may have been the source of his problems. Nicotine thins the blood, and his smoking, especially in the first hours after surgery, might have prevented the puncture in his artery from healing. Dianne decided to ask another doctor, a friend of hers, to examine the wound. He discovered the leaking artery, by now severely infected, and immediately inserted a synthetic graft to close the wound. But the infection kept it from healing. Surgery was his last option.

***

At the hospital the next afternoon, a nurse led us to his recovery room in the intensive care ward. Mom walked in first. I followed. Dad lay on a high bed in the center of the room, his arms at his side, both pierced with IVs and wrapped in a tangle of cords and tape. His eyes followed Mom as she entered. She stepped to the edge of the bed. They puckered their lips and the kiss seemed to float between them.

The vascular surgeon entered, asked Dad a few questions, and looked at the monitors. “Everything looks fine,” he said. “Just keep resting.” He left. Dad dozed off. After a few hours, Mom and I decided to go home. She moved toward him for a kiss goodbye and he woke up long enough to pucker his lips and nod. At the door, Mom turned back. “He’s sleeping,” she whispered as she stepped through the threshold.

***

Ten days after his successful surgery, Dad was transferred to a rehabilitation hospital in Mt. Clemens, where I saw him the following Saturday. He shared a room with a man who was dying of brain cancer. Dad told me about the man’s wife who visited him daily, how she’d sit at her husband’s bedside, talking to him and rubbing his arms. I looked across the room to the second bed where the man lay on his side facing us. Sunlight streamed through the narrow miniblinds and onto his swollen head, illuminating the raw spot from his failed brain surgery. I couldn’t tell whether his eyes were open or closed.

Dad glanced at the man. “It’s terrible to see something like that happen.”

“When his wife visits, does he talk to her?”

“No. I don’t think he knows anyone. He just lies there and groans. It’s really hard. I feel sorry for her.”

Later, the man’s wife came into the room. She walked to the side of Dad’s bed. He extended his hand. She squeezed it. Dad introduced me and we talked for a few minutes. Then she went to her husband and sat down next to him. Leaning her body toward him, their foreheads almost touching, she began to whisper. Dad shook his head. “It’s hard, you know, Gary. It’s really hard.”

On the long drive home, I kept thinking about Dad and the dying man. The man’s wife seemed comforted by Dad’s sympathy. More to my surprise, Dad seemed to enjoy reaching out to her. When I was home from college one summer, I met a high school friend who worked at the factory with my father. He told me about all the things that he was learning from him and said that I was lucky to have him for a father. And yet I remembered years earlier how, after arguments with him, I would ask my mother why she never got a divorce. Her response, always the same, “Families have to stay together for their children.” Over the next few weeks, these recollections wove together in my mind as I gradually adjusted to this new version of the man I had thought of as self-absorbed and, when drinking, often cruel.

***

Six weeks later Dad was scheduled to be released to home care. His doctor told us that alcohol wouldn’t mix well with his regimen of medications. Cigarettes would be less dangerous in the short run but could lead to a steep decline in the future. My mother and sister thought that Dad would fall into his old routines as soon as he returned home. He had three cases of beer and four cartons of cigarettes waiting for him. I told Mom to give it away. She refused. “He can buy all he wants at the grocery store. What’s the use?”

During a phone call to Dad on the day before his release, I asked him whether he intended to start smoking and drinking. “I don’t know, Gary. We’ll see. I haven’t quit, you know. I’m just not smoking and drinking now.” I sensed a slight opening, so I decided to write him a letter, expressing my desire to see him continue to live a healthy life after returning home. The letter began in a matter-of-fact tone, but by the third paragraph I felt tears dripping down my cheeks. “All of the things that I have loved about you over the past half century have been plucked from the past and squeezed into these last few months,” I wrote, urging him to take care of himself -- for his sake, for Mom, for Dianne and for me.

When I called him during his first few months back at home, he often asked me to tell him what happened on the night of his surgery. “Did you really think I was going to die?” I repeated that Dianne told me to pack my funeral clothes when I came home for his surgery. “I’ll be damned,” he’d say.

He mentioned my letter only once. “It means a lot to me, Gary,” he said. Then he added, “But I don’t know what will happen. We’ll see,” a response that let him control the situation without appearing weak like the hard-drinking relative who he derided for recently giving up alcohol.

A few months later, he sold the cartons of cigarettes that he had purchased before his surgery. The three cases of Stroh’s still fill the utility room refrigerator. Occasionally, a neighbor stops by and drinks a bottle. Dad always asks him whether it tastes okay. “It’s a couple years old, you know.”

My mother says that Medicare spent over a quarter million dollars to repair Dad’s 80-year-old body, a body broken by his abuse of it. She still wonders whether he deserved this medical care and the constant attention that she gave him to the point of her eventual collapse. By every measure of a medical ethicist, he was undeserving: He lacked the ability to pay. He failed to take care of himself. He was contributing little to our family and even less to society. In short, he had lived his life. He worked in a factory for 40 years to support three people who no longer needed him.

It took Mom over a year to regain her health, worn down physically from the hospital trips and mentally from the possibility of an amputee in her care. Over time, her resentment diminished. When we talk on the phone, I hear Dad in the background, making jokes and telling her not to forget to tell me some event from the past week. The stories are often about their health. “A friend of ours stopped by the other day when we were digging up the tulips,” she began. “He said that we should enjoy doing that kind of work while we still can. Then he said, ‘I can’t do it at my age. I’m 78, you know.’ Dad asked him how old he thinks we are and he said, ‘Oh, about 70.’ We told him that we’re both 81, and he couldn’t believe it. Boy, did that make us feel good.”

Dad seldom talks about his surgery. His reflections take him further back. “I really treated your mother and you guys bad. Terrible. I wish I could go back and make it right.” When I first heard him say this, I thought of his short temper, hurtful comments, and daily drinking, and wondered whether my mother’s recollections matched mine.

“What do you think?” I asked her. “Has he changed that much?”

“Oh, yes,” she said. “He’s the man I married. You never knew him.”

***

I often think of my mother’s comment and the changes in my father. Had he died, I would never have understood the void that grew out from my childhood. His death would have been merely a different form of emptiness. In the past two years, I have come to understand his life and my place in it. I see that my father shared the pain that his alcoholism caused us. I notice things about him now that I admire, and I recall the admiration that I felt for him when I was a boy.

Dianne recently told me that a few hours before his 3:00 a.m. surgery, a nurse woke Dad and had him sign a form consenting to the operation. Barely coherent at the time, he doesn’t remember signing anything. Had I, as his son, been asked to sign that form, I might have refused. He had traveled far enough toward death to seem somehow ready.

Fortunately, I didn’t have to decide for him that night. At the time, I felt certain that I knew what was best. Now I realize that no matter what your age, the future holds a kernel of possibility. On the actuarial charts of health insurance providers, my father’s life may have been lived. But on his actual chart, the line representing his engagement with life ran flat along the x-axis, blurred by alcohol for most of his adult years until, in the span of a few weeks, the equation changed. His vulnerability as he faced death seemed to move him in a way that his life never did.

When I think of him now -- his 81 years and my 50-year part in it – I realize that there are other ways to look at his life. He gave himself to the country in World War II and for the next four decades to Detroit’s auto industry. All he took in return was alcohol and tobacco, drugs that diminished him while they kept him going. Near the beginning of his ninth decade, he looked to the health care system and his family for support. The support that he received, although often deficient, was enough to pull him through.

The possibility of a transformation in the life of a man who continued to abuse his aging body seems a weak justification for a quarter-million-dollar investment. Yet, in my father’s case his physical repair led to profound change. Buddhists believe that we are born and reborn, each time with a life challenge. When we succeed in one life, we move to another challenge in the next. My father has succeeded. Perhaps this is the ultimate measure of a life – a measure perhaps too transcendental for the medical establishment to consider, but a possibility that offers hope to caregivers and family members.

***

My parents are in Florida again this winter. We talk on the phone every Sunday morning. My father initiates the calls, then waits for me to start the conversation.

“How’s things this week?” I begin.

“Too cold to swim, but I’ve been doing’ my exercises over there.”

During his recovery, Medicare paid for physical therapy sessions. Once the sessions ended, he signed up to use the exercise equipment.

“They’ve got 14 or 15 machines. I do the treadmill for ten minutes, the bicycle for five minutes. Then I go to the abs and the curls. I do them all. Some people get massages, but I don’t get that anymore.”

“So how long are you there?”

“I leave about 8:15 and get back by 9:30.”

“Is Mom sleeping when you go?”

“Well, let me put it this way. She gets up just before I leave and gives me my eye drops. Of course, I have the coffee made and everything.”

“Sounds like you’ve got a pretty good routine.”

“Yep.”